Clinical Observation Of Bloodletting Therapy On The Oxaliplatin Induced Neurotoxicity

Background and objective: Oxaliplatin(L-OHP)called l trans cyclohexane diamineoxaliplatin,which is a stereoisomer,and effects on DNA by the combination of alkylating,forming inter-and intra chain cross-linking,thereby blocking DNA synthesis and replication.It is a new type of platinum anticancer drug after cisplatin and carboplatin.In the treatment of colorectal cancer,gastric cancer,it showed excellent efficacy.However,many patients also appeared peripheral nerve or autonomic nerve dysfunction in the condition of improving the tumor at the same time,the peripheral neuropathy caused by chemotherapy has seriously affected the patient's medication treatment and quality of life.The existing clinical studies suggest that the mechanism may be mainly with platinum accumulation and its metabolites related to oxalate.It mainly to numb disease,modern medicine think "numb" pathological mechanism is related with sensory nerve conduction velocity(SCV)slowed down,which is similar to the traditional Chinese medicineof Wei Qi,Rong Qi running pretty slow.In traditional medicine,CIPN belongs to "blood stasis" and "arthromyodynia" category.The key pathogenesis is Rong Weigas shortage,blood loss free,obstruction of vein.The treatment should be supplementing qi and activating blood circulation and relieving arthralgia.Bloodletting therapy is one of the external therapy of traditional Chinese medicine,which can relieve symptoms such as pain and numbness.The purpose of this study was to observe the efficacy and safety of bloodletting on oxaliplatin induced peripheral neuropathy,and compare Using and not using this method on the improvement of instant symptoms of patients,to explore the effective method for the treatment of peripheral neuropathy.Methods: 1.Grouping and treatment:56 patients diagnosed with gastrointestinal cancer who had peripheral neurotoxicity using oxaliplatinchemotherapy,whichwere randomly divided into treatment group and control group,respectively 28 cases.The control group was treated with conventional western medicine,while the treatment group was treated with bloodletting therapy(the first and third chemotherapy day select the ten finger-tip points,twelve Jing acupoint air end points of extremities to prick blood)on the basis of routine treatment of Western Medicine,a total of 2 times.A total of 4 courses were observed.2.Assessment:Compare the improvement of instant symptoms of the two groups.And their neurotoxicity grades were classified by the general toxicity criteria(NCI-CTC)v4.0 of the National Cancer Institute every week.The symptom score of two groups of patients before and after treatment for about 1 hour(2 times after the completion of bloodletting)with Self rating symptom scale.Observe the severity and efficacy of CIPN at the end of treatment.3.Statistical Analysis: All the data were analyzed by IBM SPSS Statistics software 22.And P value less than 0.05 was statistically significant between two groups.Results: 1.Therewere no significant statistical difference of the level in the gender,age,ill-distribution,tumor stage,KPS score,chemotherapy regimen,cycles of OXA chemotherapy,dose of L-OHP cumulation and CIPN for the first time between the 2 groups.2.At the end of observation,the CIPN levels of the two groups were statistically analyzed: Comparison of baseline conditions at the end of the observation with the first appearance of CIPN,the difference was statistically significant(P<0.001).Comparison of CIPN classification in the two groups was statistically significant(P<0.05).The incidence of grade III neurotoxicity was 3.57% and 21.43% in treatment group and control group,respectively,there was significant difference between the two groups(P<0.05).3.At the end of observation,the scores of TCM syndromes in the bloodletting group and the non bleeding group were compared,the difference was statistically significant(P<0.05).4.After treatment,the total effective rate of the treatment group was 67.85%,while the control group was 35.71%,there was significant difference between the two groups(P<0.05).Conclusion: 1.Traditional Chinese medicine bloodletting therapy can obviously improve the peripheral nerve toxicity caused by oxaliplatin chemotherapy.2.Chinese medicine bloodletting therapy can relieve the symptoms of TCM syndromes in CIPN patients.3.Chinese medicine bloodletting therapy take effect by improving the microcirculation of the extremities and removing toxic substances,curative effect is better than Mecobalamin,the specific mechanism needs further exploration.